Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study.

BACKGROUND: Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic. METHODS: This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15-49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. RESULTS: The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women's age, area of residence, mother tongue of household head, age of husband, and number of children ever born. CONCLUSION: The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.

Erratum: Increased number of live births by migrant mothers shows areal inequality in Japan: A descriptive study.

[This corrects the article DOI: 10.1016/j.ssmph.2023.101531.][This corrects the article DOI: 10.1016/j.ssmph.2023.101447.].

Proposal for Classifying the Emetogenicity of Oral Anticancer Agents with a Focus on PARP Inhibitors: A Prospective, Observational, Multicenter Study (JASCC-CINV 2002).

Background: Olaparib and niraparib (poly adenosine diphosphate [ADP]-ribose polymerase [PARP] inhibitors) have significant antitumor action in patients with ovarian cancer. However, the incidence of nausea and vomiting among patients on these drugs in clinical trials is rather high. There are no guidelines on antiemetic treatment for nausea caused by oral anticancer agents. This study aimed to investigate the incidence of nausea and vomiting caused by PARP inhibitors and the actual situation of antiemetic therapy in patients with gynecologic cancer. Methods: Patients with gynecologic cancer who were scheduled to receive PARP inhibitors were enrolled. Data on PARP inhibitor-induced nausea and vomiting were collected from patient diaries for 21 days. The primary endpoint was the incidence of vomiting during the 21 days after starting olaparib and niraparib. Results: Overall, between January 2020 and March 2023, 134 patients were enrolled. Of the 129 patients who were evaluated, 28 (21.7%) received prophylactic antiemetics for 21 days, and 101 (78.3%) did not. The overall incidence of PARP inhibitor-induced vomiting was 16.3%. The incidence of vomiting in the group that did not receive antiemetic prophylaxis was 13.9%. On dividing the group that did not receive antiemetic prophylaxis into the olaparib and niraparib subgroups, the incidence of vomiting was found to be 18.6% for the olaparib group and 10.3% for the niraparib group. Conclusion: The incidence of emesis without antiemetic prophylaxis among patients on olaparib and niraparib ranged from 10% to 30%. Therefore, olaparib and niraparib can be classified in the low emetogenic risk and prophylactic antiemetic therapy at the time of treatment initiation may be unnecessary.

Establishment and characterization of a non-gestational choriocarcinoma patient-derived xenograft model.

BACKGROUND: Non-gestational choriocarcinoma (NGC) is a rare subtype of malignant germ cell tumour and there is no consensus on its treatment. The lack of suitable preclinical models for NGC is a challenge in drug discovery research. Patient-derived xenograft (PDX) models recapitulate the tumour microenvironment of the original cancer tissue. Therefore, they have received considerable attention for studies on rare cancer. Here, we aimed to establish a PDX model from a patient with recurrent NGC. METHODS: Fresh NGC tumour tissue was immediately transplanted into a severely immune-deficient mouse (NOD.Cg-Prkdcscid1l2rgtm1Wjl/SzJ) and maintained for more than three in vivo passages. Subsequently, we evaluated the molecular characteristics of the PDX model using immunohistochemistry, polymerase chain reaction, and RNA sequencing. Moreover, the PDX tumours were transplanted into BALB/c nude mice, and we evaluated their sensitivity for cisplatin and methotrexate. RESULTS: The PDX tumour maintained the morphological features of NGC. Moreover, Immunohistochemistry revealed that the human chorionic gonadotropin, cytokeratin 7, and EpCAM expression levels were similar to those in the primary tumour. Furthermore, serum human chorionic gonadotropin levels were elevated in both the primary tumour and the PDX models. Additionally, using PCR analysis with species-specific primers, we confirmed that the PDX tumour contained human genes and was derived from human tissue. Moreover, the gene expression profile of the NGC was compared with that of epithelial ovarian cancer samples and cell lines, and 568 dysregulated genes in the NGC were extracted. The expression of the dysregulated genes in PDX was significantly correlated with that in the primary tumour (R2 = 0.873, P < 0.001). Finally, we demonstrated that the PDX tumour was sensitive to cisplatin and methotrexate; therefore, its clinical response to the agents was similar to that of the primary tumour. CONCLUSIONS: We successfully established a PDX model of NGC, to the best of our knowledge, for the first time. The established PDX retained the molecular and transcriptome characteristics of the primary tumour and can be used to predict drug effects. It may facilitate further research and the development of novel therapeutic agents for NGC.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey.

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

Increased number of live births by migrant mothers shows areal inequality in Japan: A descriptive study.

Japan has not implemented policy of accepting many migrants, and the proportion of migrants in the total population is much smaller than that in other economically developed countries. Therefore, issues regarding the health status of migrants, especially migrant mothers and their children, have not been discussed enthusiastically in Japan. In the present study, we aimed to describe the epidemiology (time trend of the number, areal distribution, and frequency of maternal nationality of newborn births) of live births by migrant mothers in Japan, which contributes to the administration of medical policies on the perinatal care of migrant mothers. This study used data from the vital statistics reported by the Ministry of Health, Labour and Welfare (MHLW) of Japan and from foreign resident statistics reported by Immigration Services Agency (ISA) of Japan. To show areal inequality in the number of live births by migrant mothers, we applied the Gini coefficient. This study demonstrated that the number of live births by migrant mothers increased from 16,154 (1.31% of the total) in 1990 to 26,517 (3.08%) in 2020. It also showed stronger areal inequality at prefecture level by Japanese mothers (Gini coefficient; 0.64 vs 0.46 in 2020), and this areal inequality has increased during the last decade. This study also illustrated that the frequency of maternal nationality of newborns from migrant mothers has been altered in the last decade, especially in the composition of Asian countries. In conclusion, the number of live births by migrant mothers in Japan has been progressively increasing; however, this trend is excessively concentrated in specific areas in Japan. These tendencies are expected to become more prominent in the future, and their possible impacts on medical institutions and administrative agencies in specific areas that treat migrant mothers should be investigated and discussed.

A case of complete remission of intractable gestational choriocarcinoma with subsequent chemotherapy after pembrolizumab.

OBJECTIVE: Gestational choriocarcinoma is a gestational trophoblastic neoplasia (GTN) that originates from abnormal trophoblast proliferation. Although chemotherapy is effective for choriocarcinoma, personalized treatment becomes essential when patients develop chemoresistance. Here, we present the clinical course of a case of intractable choriocarcinoma that achieved complete remission with pembrolizumab following cytotoxic chemotherapy. CASE REPORT: A 38-year-old woman was initially diagnosed with low-risk GTN and treated with single- and multi-agent chemotherapy. She underwent a hysterectomy and was diagnosed with pathological choriocarcinoma with high-risk GTN. She was treated with multiple courses of several chemotherapy regimens. However, she did not achieve remission. Her choriocarcinoma showed high microsatellite instability; therefore, she took ten courses of pembrolizumab, but her hCG value increased. Subsequently, she underwent eight courses of paclitaxel and carboplatin alternating with paclitaxel and etoposide and achieved remission. CONCLUSION: This case suggests that pembrolizumab may improve the efficacy of subsequent chemotherapy.

Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study.

INTRODUCTION: This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan. METHODS: The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis. RESULTS: The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers. CONCLUSIONS: Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.

Period shaming behavior among male students in Luang Prabang Province, Lao People's Democratic Republic: A cross-sectional study.

Period shaming is defined as any negative and/or disrespectful behavior in relation to the menstrual cycle and menstruating girls. It is suggested that period shaming may limit girls' potential and ability to fully participate in school and community activities. This study aims to examine the prevalence and factors associated with period shaming among male students in Luang Prabang Province, Lao People's Democratic Republic (Lao PDR). This was a cross-sectional study which was conducted during November 19-27, 2020. This study included 1,232 male students from secondary school grade 9 to 12 in Luang Prabang Province, Lao PDR. Informed consent was obtained from the participants, parents/guardians, and teachers prior to data collection. The data was collected by a self-administered questionnaire. Logistic regression was employed to examine factors associated with period shaming behavior among male students. The mean age of the participants was 16.4 years old. Of all the male students, 18.8% admitted that they had shamed girls during their menstruation at least once. Of those who committed period shaming, they shamed girls some of the times (63.2%). Male students who had consumed alcohol during the last month before the data collection day (AOR = 1.83, 95% CI 1.32-2.55, P<0.001), had heard of menstruation (AOR = 1.76, 95% CI 1.27-2.44, P<0.001), and those who had attended activities/classes about sexual reproductive health (AOR = 1.90, 95% CI 1.29-2.78, P<0.01), were significantly associated with period shaming behavior. In conclusion, a single focus on providing biological health education may not be enough to address menstrual stigmatization and taboos. The school curriculum should integrate other life skill education with reproductive health, such as respect and gender equality, to encourage behavioral changes among male students, to address menstrual stigma and to support and empower girls' menstrual health at school and in the community.

Assessment of the underlying causes of adult deaths using a short version of verbal autopsy in Xaiyabouli Province, Lao People's Democratic Republic.

BACKGROUND: In developing countries, it is difficult to collect the data of the underlying cause of death (UCOD), especially when a death does not occur in a health facility. This study aimed to develop a short version of verbal autopsy (VA) and identify the UCOD of adults in Lao People's Democratic Republic (Lao PDR). METHODS: A short version of VA for deaths outside health facilities was developed. This study included all deaths of people aged 15 years old or older in Xaiyabouli Province in 2020. Socio-demographic factors, place of death, and UCOD of the deceased were collected from health facilities or from family members using a questionnaire including the short VA form. UCOD was compared between home deaths and hospital deaths, between the age group of 15-59 years old and the age group ≥ 60 years old, and between males and females. RESULTS: Of all the 1,235 deaths included in this study, 1,012 deaths (81.9%) occured at home and 223 deaths (18.1%) at hospitals. The most common UCOD was senility (13.3%), followed by heart/renal failure (10.5%), pneumonia (9.6%) and traffic accident (7.1%). Compared to hospital deaths, home deaths had more people who were females, 75 years old or older, and Lao-Tai. Home deaths had more deaths than hospital deaths due to accident/injury (16.0% vs. 8.1%), tumor (4.7% vs. 1.8%), and senility (16.2% vs. 0%); fewer deaths due to heart/renal disease (15.1% vs. 32.3%), respiratory disease (12.2% vs. 18.8%), liver/gastro-intestine disease (5.3% vs. 9.0%), and infection (3.1% vs. 14.3%). The age group of 15-59 years had more deaths in the categories of accident/injury (28.1% vs. 4.4%), liver/gastro-intestine disease (8.1% vs. 4.4%), infection (7.2% vs. 3.5%), and tumor (6.0% vs. 2.8%). Males had more deaths due to tumor (5.2% vs. 3.0%) and fewer natural deaths (11.2% vs. 15.9%) than females. CONCLUSIONS: The major UCOD category was heart/renal disease in the adult generation in Xaiyabouli Province. Cost-effective interventions based on the multisectoral noncommunicable disease prevention plan should be appropriately implemented. Mortality surveillance using the short VA tool should be conducted for all home deaths in Lao PDR.

Causes of death, three delays, and factors associated with Delay 1 among maternal deaths in Myanmar: The maternal death surveillance in 2019.

OBJECTIVE: The maternal mortality ratio (MMR) in Myanmar was the highest in Southeast Asia in 2017. The Three Delay Model is used to evaluate delays that contribute to maternal deaths. This study aims to identify MMR, causes of death, the three delays related to maternal deaths, and the factors associated with Delay 1, which is the time of delay in deciding to seek health care (from the start of the woman's illness to the time when the problem is recognized to be requiring care), in Myanmar. STUDY DESIGN: A cross-sectional study. PARTICIPANT: This study included 934 cases of maternal deaths reported from all states and regions throughout Myanmar in 2019 that were not caused by accidents and injuries. MATERIALS AND METHODS: Socio-demographic factors, obstetrical factors, information about deaths, and assessment of delays were obtained from the Maternal Death Surveillance and Response System, the database of maternal deaths. Distribution of maternal deaths by states and regions, causes of maternal death, and types of delay that contributed to maternal deaths were descriptively summarized. Logistic regression analysis was performed to identify factors associated with Delay 1 among 567 maternal deaths without any missing data and unknown information on delays. FINDINGS: In 2019, the MMR was 106 (95% confidence interval, 99-112) per 100,000 live births. Of the 934 maternal deaths, 80.5% of deaths had at least one delay, and Delay 1 was the major delay (72.9%). Eclampsia/pre-eclampsia (21.6%), postpartum hemorrhage (18.2%), and abortion-related complications (13.2%) were the major causes of maternal death. The husband's low education, low household income, unplanned pregnancy, and no antenatal care were associated with Delay 1. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: The MMR was lower in 2019 than that in 2017 but remained high. Moreover, we demonstrate that most maternal deaths had at least one delay, mostly Delay 1. To prevent maternal deaths caused by Delay 1, the family planning should be promoted to prevent unplanned pregnancies. Educational training for healthcare providers who deliver antenatal care should be strengthened. Furthermore, education on the danger signs of pregnancy and during childbirth should be provided not only to pregnant women and their husbands in communities at health facilities.

Drug library screening identifies histone deacetylase inhibition as a novel therapeutic strategy for choriocarcinoma.

BACKGROUND: Choriocarcinoma is a rare and aggressive gynecological malignancy. The standard treatment is systemic chemotherapy as choriocarcinoma exhibits high chemosensitivity. However, refractory choriocarcinoma exhibits chemoresistance; thus, the prognosis remains very poor. This study aimed to identify novel therapeutic agents for choriocarcinoma by utilizing a drug repositioning strategy. METHODS: Three choriocarcinoma cell lines (JAR, JEG-3, and BeWo) and a human extravillous trophoblast cell line (HTR-8/SVneo) were used for the analyses. The growth inhibitory effects of 1,271 FDA-approved compounds were evaluated in vitro screening assays and selected drugs were tested in tumor-bearing mice. Functional analyses of drug effects were performed based on RNA sequencing. RESULTS: Muti-step screening identified vorinostat, camptothecin (S, +), topotecan, proscillaridin A, and digoxin as exhibiting an anti-cancer effect in choriocarcinoma cells. Vorinostat, a histone deacetylase inhibitor, was selected as a promising candidate for validation and the IC50 values for choriocarcinoma cells were approximately 1 µM. RNA sequencing and subsequent pathway analysis revealed that the ferroptosis pathway was likely implicated, and key ferroptosis-related genes (i.e., GPX4, NRF2, and SLC3A2) were downregulated following vorinostat treatment. Furthermore, vorinostat repressed tumor growth and downregulated the expression of GPX4 and NRF2 in JAR cell-bearing mice model. CONCLUSION: Vorinostat, a clinically approved drug for the treatment of advanced primary cutaneous T-cell lymphoma, showed a remarkable anticancer effect both in vitro and in vivo by regulating the expression of ferroptosis-related genes. Therefore, vorinostat may be an effective therapeutic candidate for patients with choriocarcinoma.

Factors associated with positive cancer screening for the uterine cervix and breast in Jakarta Province, Indonesia: a cross-sectional study.

BACKGROUND: In many middle-income countries, cancer incidence and mortality are rapidly increasing, but data for developing a strategy of cancer control are rarely collected or analyzed. This study aimed to identify factors associated with positive cancer screening for the uterine cervix and breast in Jakarta Province, Indonesia. METHODS: The data of 79,660 women who had visual inspection with acetic acid (VIA) and 83,043 women who had clinical breast examination (CBE) in the Jakarta Women Cancer Screening program in 2019 were included in this study. Socio-demographic factors, reproductive factors, lifestyle factors, family history, and the results of VIA and CBE were used for analyses. Binary and multivariate logistic regression analyses were performed to identify factors associated with VIA positive or CBE positive. RESULTS: The positive rate was 0.9% for both VIA and CBE among the screening participants. Factors associated with VIA positive were age < 30 years old, age at menarche ≤ 11 years old, remarriage, lower educational level, having an occupation, partner's occupation other than being an employee, alcohol consumption, smoker, inadequate physical activity, cancer family history, and no Pap smear history. Factors associated with CBE positive were age at menarche ≤ 11 years old, widowed, high education, having an occupation, no breastfeeding history, birth control history, alcohol consumption, smoker, inadequate physical activity, cancer family history, and breast tumor history. CONCLUSION: Factors associated with VIA positive and CBE positive among Indonesian women were revealed. To promote female cancer prevention in Indonesia, the prevalence of screenings should be increased and education about the risk factors should be provided to medical professionals.

Epidemiologic study on gestational trophoblastic diseases in Japan.

OBJECTIVE: This study aims to estimate the population-based incidence of gestational trophoblastic diseases (GTDs) and to identify the characteristics of gestational trophoblastic neoplasia (GTN) in Japan. METHODS: The annual number of GTD and live births from 1974 to 2018 were used to estimate the incidence of GTD. The data of 1,574 GTN cases from 1999 to 2018 were analyzed to identify the characteristics of low-risk GTN, high-risk GTN, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). RESULTS: The incidence of hydatidiform mole was 2.02 per 1,000 live births on average which decreased from 1974 to 2008 and increased from 2009 to 2018. The incidence of low-risk GTN, high-risk GTN, PSTT, and ETT was 15.3, 3.5, 0.3, and 0.07 per 100,000 live births, respectively. The estimated incidence of post-molar GTN was 9.8% of molar patients. High-risk GTN was diagnosed more pathologically, had more various kinds of antecedent pregnancies, and had longer intervals after the antecedent pregnancy compared to low-risk GTN. Furthermore, 8.2% of high-risk GTN occurred after the subsequent non-molar pregnancy of hydatidiform mole. The cumulative percentage of developing high-risk GTN after hydatidiform mole reached 89.3% at the 60th month. CONCLUSION: The incidence of hydatidiform mole, low-risk GTN, high-risk GTN was 2.02 per 1,000 live births, 15.3 per 100,000 live births, and 3.5 per 100,000 live births, respectively. High-risk GTN was diagnosed more pathologically and later after the antecedent pregnancy than low-risk GTN. Following molar patients for five years is needed to improve the mortality of malignant GTN.

Peritoneal restoration by repurposing vitamin D inhibits ovarian cancer dissemination via blockade of the TGF-ß1/thrombospondin-1 axis.

Ovarian cancer (OvCa), a lethal gynecological malignancy, disseminates to the peritoneum. Mesothelial cells (MCs) act as barriers in the abdominal cavity, preventing the adhesion of cancer cells. However, in patients with OvCa, they are transformed into cancer-associated mesothelial cells (CAMs) via mesenchymal transition and form a favorable microenvironment for tumors to promote metastasis. However, attempts for restoring CAMs to their original state have been limited. Here, we investigated whether inhibition of mesenchymal transition and restoration of MCs by vitamin D suppressed the OvCa dissemination in vitro and in vivo. The effect of vitamin D on the mutual association of MCs and OvCa cells was evaluated using in vitro coculture models and in vivo using a xenograft model. Vitamin D restored the CAMs, and thrombospondin-1 (component of the extracellular matrix that is clinically associated with poor prognosis and is highly expressed in peritoneally metastasized OvCa) was found to promote OvCa cell adhesion and proliferation. Mechanistically, TGF-ß1 secreted from OvCa cells enhanced thrombospondin-1 expression in CAMs via Smad-dependent TGF-ß signaling. Vitamin D inhibited mesenchymal transition in MCs and suppressed thrombospondin-1 expression via vitamin D receptor/Smad3 competition, contributing to the marked reduction in peritoneal dissemination in vivo. Importantly, vitamin D restored CAMs from a stabilized mesenchymal state to the epithelial state and normalized thrombospondin-1 expression in preclinical models that mimic cancerous peritonitis in vivo. MCs are key players in OvCa dissemination and peritoneal restoration and normalization of thrombospondin-1 expression by vitamin D may be a novel strategy for preventing OvCa dissemination.

Is adjuvant chemotherapy necessary for young women with early-stage epithelial ovarian cancer who have undergone fertility-sparing surgery?: a multicenter retrospective analysis.

OBJECTIVE: In young patients with early-stage epithelial ovarian carcinoma (EOC) who were received fertility-sparing surgery (FSS), the role of adjuvant chemotherapy is unclear. Here, we performed a multicenter study using inverse probability of treatment weighting (IPTW) to explore the effect of chemotherapy on patients' survival. METHODS: Between 1987 and 2015, a retrospective study was carried out, including 1183 patients with stage I EOC. Among them, a total of 101 women with stage I EOC who underwent FSS were investigated, including 64 and 37 patients with or without adjuvant chemotherapy, respectively. Oncologic outcomes were compared between the two arms using original and IPTW cohorts. RESULTS: During 62.6 months (median) of follow-up, recurrence was noted in 11 (17.2%) women in the chemotherapy arm and 6 (16.2%) patients in the observation arm. In the unweighted cohort, the 5-year overall and recurrence-free survival (OS/RFS) rates of chemotherapy and observation arms were 86.3/80.8 and 90.2/79.8%, respectively. There was no significant difference between the two groups {Log-rank: P = 0.649 (OS)/P = 0.894 (RFS)}. In the IPTW cohort after adjusting for various clinicopathologic covariates, we also failed to identify a difference in RFS/OS between the two groups {RFS (chemotherapy vs. observation), HR: 0.501 (95% CI 0.234-1.072), P = 0.075: OS (chemotherapy vs. observation), HR: 0.939 (95% CI 0.330-2.669), P = 0.905}. CONCLUSIONS: Even after adjusting clinicopathologic covariates, performing adjuvant chemotherapy may not improve the oncologic outcome in young patients who have undergone FSS.

Is cystectomy an option as conservative surgery for young patients with borderline ovarian tumor? A multi-institutional retrospective study.

OBJECTIVE: To investigate the impact of cystectomy for borderline ovarian tumor (BOT) on tumor recurrence compared with salpingo-oophorectomy using inverse probability of treatment weighting (IPTW). METHODS: A central pathologic review and a search of the medical records from 14 collaborating institutions from 1986 to 2017 identified 4708 women with a malignant ovarian neoplasm. Data for young women with Stage I BOT were extracted. To compare recurrence-free survival between the surgery groups, Cox regression analyses and the IPTW-adjusted Kaplan-Meier method were employed. RESULTS: During a median follow-up of 62.0 (1.2-270.4) months, 10 of the 285 patients identified (3.5%) developed recurrence. In multivariate analysis, the practice of cystectomy was not a significant prognostic indicator of recurrence-free survival (hazard ratio [95% confidence interval] 1.276 [0.150-10.864]; P = 0.823). In the IPTW-adjusted cohort, the 5-year recurrence-free survival rates were 95.8% and 96.0% in patients receiving cystectomy and salpingo-oophorectomy, respectively (P = 0.378). CONCLUSION: If patients are selected appropriately, cystectomy in itself may not increase tumor recurrence in young women with early-stage BOT. A large-scale prospective clinical study is necessary to validate this finding.

Cell surface membrane lysosome-associated membrane glycoprotein 2 promotes cell adhesion via abundant N-glycans in choriocarcinoma.

INTRODUCTION: Lysosome-associated membrane glycoprotein 2 (LAMP-2) is a target protein for glycosylation by N-acetylglucosaminyltransferase IV (GnT-IV), which catalyzes the formation of ß1,4GlcNAc branches on the mannose core of N-glycans in choriocarcinoma cells. However, the role of LAMP-2, especially when it is expressed in the cell surface membrane of choriocarcinoma cells, has not been well investigated in the progression of choriocarcinoma. This study aimed to elucidate the function of the cell surface membrane LAMP-2 in the malignancy of choriocarcinoma. METHODS: We evaluated the localization of LAMP-2 in some choriocarcinoma cell lines and clinical samples of choriocarcinoma, normal placenta, hydatidiform mole, and invasive mole by flow cytometry, immunocytochemistry, and immunohistochemistry. We performed functional experiments using the knockout or overexpression model of LAMP-2 in the presence or absence of galectins. RESULTS: LAMP-2 was observed in the cell surface membrane of some choriocarcinoma cell lines and tumor cells of choriocarcinoma tissue and trophoblasts of the placenta, hydatidiform mole, and invasive mole. Cell surface membrane LAMP-2 knockout decreased cell adhesion and invasion in choriocarcinoma cells. Conversely, cell surface membrane LAMP-2A overexpression increased cell adhesion and invasion. Experiments in the presence of galectins revealed that abundant N-glycans bound to the peptide core of the luminal side of the cell surface membrane LAMP-2 mediated cell adhesion of choriocarcinoma cells by interacting with galectins in the extracellular matrix (ECM). DISCUSSION: Cell surface membrane LAMP-2, which is glycosylated by GnT-IV, contributes to the malignancy of choriocarcinoma by promoting cell adhesion with the ECM via abundant N-glycans.

Laparoscopic pelvic surgery after reconstructive surgery with vertical rectus abdominis muscle flap: A case report.

INTRODUCTION: Patients who have experienced vertical rectus abdominis muscle (VRAM) flap reconstruction are under risk of the abdominal incisional hernia (donor site hernia), and laparotomy increases the risk. PRESENTATION OF THE CASE: We present the case of a 71-year-old nulliparous woman who experienced radical vulvectomy against extramammary Paget disease and reconstructive surgery with VRAM flap 7 years ago and developed right ovarian tumor. In this case, right ovarian tumor was removed with laparoscopic surgery, instead of laparotomy, and the risk of incisional hernia was successfully minimized. DISCUSSION: Incisional (donor site) hernia after reconstructive surgery using VRAM flap has been reported in between 2 and 10%. While VRAM flap can fill larger amount of skin and subcutaneous tissue to recipient site, the risk of postoperative incisional hernia of abdominal wall is substantial. CONCLUSION: Reconstructive surgery of with VRAM flap is required for extramammary vulvar Paget disease expanding wide range, and develops the risk of incisional hernia. Laparoscopic surgery should be applied in patients who have experienced VRAM flap reconstruction and developed pelvic tumor for avoiding the risk of incisional hernia as long as it can be allowed on oncologic aspects such as recurrence.

Clinical effects of cervical conization with positive margins in cervical cancer.

Radical surgery after cervical conization is a common approach for the treatment of cervical cancer. In some cases, disease progression is observed after positive margins at conization, but the effect of conization on disease progression remains unclear. Thus, the aim of this study was to investigate the clinical outcomes of positive margins at conization in cervical cancer. A total of 101 patients who underwent cervical conization before radical hysterectomy and pelvic lymph node dissection were considered eligible by reviewing medical records. The association between the positive margins and patient outcomes, including subsequent lymph node metastasis, was evaluated. The rate of lymphovascular space invasion (LVSI) positivity at radical surgery was significantly higher in patients with positive margins (p = 0.017) than in those with negative margins, although there was no significant difference in the rate of pelvic lymph node metastasis (p = 0.155). Moreover, there was no significant difference in the overall survival or progression-free survival between the two groups (p = 0.332 and 0.200, respectively). A positive margin at conization presented no significant prognostic disadvantage; thus, diagnostic conization is one of the most suitable treatment options for early-stage cervical cancer that is difficult to accurately assess.